“The American Academy of Pediatrics believes that healthy children receiving a normal, well-balanced diet do not need vitamin supplementation over and above the recommended dietary allowances, which includes 400 IU (International Units) of vitamin D a day in infants less than 1 year of age and 600 units/day for children over 1 year of age.”

AAP on Where We Stand: Vitamins

It depends. Most kids don’t actually need to take any extra vitamins.

Which Vitamins Should My Kids Take?

Follow the My Plate guidelines to make sure your kids are getting enough vitamins and minerals.

Wait, if all kids need vitamins, then why don’t you need to give them extra vitamins?

That’s easy. Most kids should get enough vitamins from the foods they eat.

Are your kids missing out on something? Then that would be a clue on which vitamins and minerals they would need to take.

Does your child have a chronic medical condition?

Are they on a special or restrictive diet?

Even if they are a little picky or don’t eat as much as you like, do they eat some foods from each food group, leading to a balanced diet by the end of the week?

In general, to see what your child might need, focus on your child’s intake of:

iron – can be low (anemia) in preterm babies, when infants are exclusively breastfeeding and not eating foods with iron, toddlers and preschoolers who are drinking excessive amounts of cow’s milk and not eating foods with iron, other kids who don’t eat many foods with iron, and teen girls who have heavy periods

vitamin D – can be low when infants are exclusively breastfeeding and don’t take a daily vitamin D supplement and older children who don’t eat or drink enough foods with vitamin D, including milk, cheese, yogurt, and orange juice

calcium – can be low when children don’t eat or drink enough foods with calcium, including milk, cheese, yogurt, and orange juice

fluoride – can be deficient when children mainly drink bottled water, soda, and juices, but since too much fluoride can lead to tooth staining, it is best to get fluoride from drinking fluoridated water – offer it daily once your child is about six months old

vitamin B12 and folate – can become classically low in vegans (who don’t take a supplement) and kids who drink goat milk that’s not fortified with vitamin B12 and folate

vitamin C – rarely low, which would cause scurvy, as most fruits and fruit juices are high in vitamin C

What other things do parents think about supplementing?

protein – while many parents worry that their kids aren’t getting enough protein in their diets, protein is rarely the thing that they are missing out on, as only about 20 percent of our calories need to come from protein.

calories – if your child is a picky eater, you might think that they aren’t getting enough calories and might think of supplementing them with a shake or two to boost their calories, but keep in mind that these typically end up replacing meals, leading kids to eat even less food and teach them to just drink their calories

vitamin K – typically only a problem for breastfeeding newborns who didn’t get a vitamin K shot, as vitamin K is found in many foods

vitamin A – since milk and many other foods are fortified with vitamin A, this is rarely a vitamin that we worry about being low. Supplements are also a concern, because too much vitamin A can be toxic.

Best Vitamins and Supplements for Kids

Once you figure out which vitamins and minerals your kids need, you have to figure out the best way to make sure they get them, understanding that the answer isn’t always going to be a gummy vitamin.

You also will likely need a different supplement if you are actually treating a deficiency vs if you are just trying to prevent your child from developing a deficiency in the first place.

So the best supplement(s) might be:

a multivitamin with iron – keeping in mine that gummy vitamins typically don’t contain iron, so if your main concern is that your child isn’t getting enough iron, then you should give your child an iron vitamin or a multivitamin with iron. Also low in calcium. Either liquid (infants), chewable, or tablets.

a multivitamin without iron – keeping in mine that in addition to not containing iron, these types of multivitamins also often don’t contain very much calcium. Often available as liquid (infants), gummies, chewables, and tablets.

a vitamin D supplement – was your child’s vitamin D level low or do you just think that he doesn’t get enough vitamin D in his diet? These are typically available as liquid, gummies, chewables, and tablets.

a calcium supplement – These are typically available as gummies, chewables, and tablets.

a vitamin D supplement combined with calcium – These are typically available as gummies, chewables, and tablets.

an iron supplement – if your child’s iron was low, then they will likely need an iron supplement, like Feosol, Niferex, or Fer-In-Sol. Either liquid or tablets.

a fluoride supplement – do you live in an area where the water isn’t fluoridated? Do you use a reverse osmosis system that filters out fluoride? Usually available as a prescription only. Or you can buy ‘baby water’ with added fluoride.

Again, remember that unless your child has already been diagnosed with a deficiency, you can often work to get your kids to eat more foods with these nutrients instead of giving them an extra supplement, including vitamin fortified foods.

Look to you pediatrician and a registered dietician if you need extra help.

More people seem to be getting the message that too little vitamin D in our diets can lead to health problems. In addition to being at risk of developing rickets (extreme vitamin D deficiency), children with milder forms of vitamin D deficiency can develop weak bones and muscle weakness.

Why is vitamin D so important?

Vitamin D is a hormone that helps our bodies absorb both calcium and phosphorous, two very important minerals that help keep our bones strong.

Without enough vitamin D, we absorb 85-90% less of the calcium in our diet! And then, to keep calcium levels normal, our bodies pull more calcium out of our bones, causing osteopenia and osteoporosis.

Some experts also think that a low vitamin D level is associated with other conditions that are not linked to calcium and our bones, including some psychiatric conditions. The American Academy of Pediatrics even states that “new evidence suggests that vitamin D plays a vital role in maintaining innate immunity and has been implicated in the prevention of certain disease states including infection, autoimmune diseases (multiple sclerosis, rheumatoid arthritis), some forms of cancer (breast, ovarian, colorectal, prostate), and type 2 diabetes mellitus.”

The role of vitamin D in preventing infections, cancer, or anything else beyond preventing and treating vitamin D deficiency (extraskeletal effects) is far from proven though. In fact, a 2010 investigation by the Institute of Medicine (IOM) didn’t find any evidence to support a role for vitamin D in any other health conditions besides supporting bone health.

Surprisingly to many people, the IOM report also found that most people in North America are already getting enough calcium and vitamin D in their diet and that getting too much can be harmful. They also warned that “the number of people with vitamin D deficiency in North America may be overestimated because many laboratories appear to be using cut-points that are much higher than the committee suggests is appropriate.”

Tests for Vitamin D Deficiency

Although vitamin D testing seems to becoming part of the routine screening tests that some doctors order, it is important to keep in mind that only those at risk for having low levels should be routinely tested.

Are your kids at risk for vitamin D deficiency?

These high risk children can include:

exclusively breastfed infants who don’t get a vitamin D supplement

babies born to mothers with a vitamin D deficiency, especially premature babies

obese children, because vitamin D is stored in fat tissue and is not readily available for use

children with dark skin, who live at high latitudes, and/or spend a lot of time indoors (less vitamin D from sun exposure)

children taking certain medications, including antiseizure medications and oral steroids

children who simply don’t get enough vitamin D – at least 400-600 IU of vitamin D each day, depending on their age. This might include vegetarians, vegans, and children who simply don’t drink vitamin D fortified cow’s milk, soy milk, or almond milk, etc., or other foods that are high in vitamin D.

If your child falls into one or more of these risk factors for vitamin D deficiency, then talk to your pediatrician about testing his vitamin D levels.

Although different tests are available, the test that is recommended by the AAP and the Endocrine Society is the serum 25(OH)D level (25-hydroxyvitamin D). This actually measures the levels of a prehormone of vitamin D, calcifediol, but is thought to give a good idea of a person’s vitamin D status.

This vitamin D test is preferred over testing 1,25(OH)2D levels, another test that is available, as those levels can be normal or even elevated when someone has a vitamin D deficiency. Similarly, measuring vitamin D levels (the active hormone) has not been found to be helpful. Instead, we use 25(OH)D levels as a marker for vitamin D levels.

Treating Vitamin D Deficiency

Is your child’s vitamin D level low?

That question is a actually a little harder to answer than you might realize. According to the IOM, in discussing cut-points for 25(OH)D levels, or what’s low and what’s normal, “At this time, there is no central body that is responsible for establishing such values for clinical use.”

The serum 25(OH)D level is typically defined as low (vitamin D deficiency) in children if it is below 20 ng/ml. Some experts think that a 25(OH)D level above 16 ng/ml is normal for infants and children though.

Experts do agree that a level below 5 ng/ml is a sign of a severe vitamin D deficiency.

Recommendations for treating children with low vitamin D levels depend on their age, and might include:

newborns: 1,000 IU /day vitamin D2 or D3

children 1 to 12 months old: 2,000 IU /day vitamin D2 or D3

children > 12 months old: 2,000 IU /day vitamin D2 or D3

These vitamin D supplements, together with adequate amounts of calcium, are usually continued for at least 1 to 3 months, at which time the child’s serum 25(OH)D level can be repeated to make sure it is responding to treatment.

“The upper limit for vitamin D is 1,000 to 1,500 IU/day for infants, 2,500 to 3,000 IU/day for children 1-8 years, and 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating teens and women. Vitamin D toxicity almost always occurs from overuse of supplements.”

NIH Vitamin D Fact Sheet for Consumers

The Endocrine Society also advises that some children can take 50,000 IU of vitamin D2 once a week as an alternative treatment for vitamin D deficiency. Since you can definitely get too much vitamin D, be sure to talk to your pediatrician and make sure your child is getting the right dose before starting a treatment regimen for vitamin D deficiency.

Preventing Vitamin D Deficiency

Once you get your child’s vitamin D levels back into a normal range, it is important to take steps so that they don’t drop again.

To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that healthy infants get at least 400 IU of vitamin D each day, while older children – toddlers to teens – get at least 600 IU. This vitamin D should come from some combination of:

What about sunlight? Can’t your kids just spend more time in the sun to boost their vitamin D levels?

Although we all have the ability to make vitamin D when we are out in the sun, it isn’t considered a good source of vitamin D. Intentional, unprotected (no sunscreen) exposure to the sun has risks of sunburn and skin cancer. And it is very hard to judge how much sun exposure is necessary to get adequate amounts of vitamin D. The intensity of the sun’s radiation varies greatly in different parts of the world and at different times of year and will also affect how much vitamin D your body makes.

Other Things To Know about Vitamin D Deficiency

Raw milk, in addition to being unprocessed and unpasteurized, is unfortified and has very little vitamin D.

Although other foods may be fortified with vitamin D, in the United States, only milk, margarine, infant formula, and “fortified-plant based beverages” are mandated by the FDA to be vitamin D fortified.

In addition to low 25(OH)D levels, children with vitamin D deficiency will often have low phosphorous, high alkaline phosphatase, and high parathyroid hormone levels. These levels might be checked and monitored when kids are treated for vitamin D deficiency.

Vitamin D2 (ergocalciferol, derived from plants) and vitamin D3 (cholecalciferol, derived from animals) are two major forms of vitamin D. Some experts think that vitamin D3 is more potent than vitamin D2, especially at higher doses. Still, these prohormones are converted to the same active form of vitamin D (calcitriol) in the liver and kidney.

Some experts think that 25(OH)D levels between 21 and 30 ng/ml are a sign of vitamin D insufficiency in children, as in adults, and are a sign that the child needs more vitamin D in their diet.

Although the use of sunscreen can block the synthesis of vitamin D by blocking UVB radiation and has been blamed for lower vitamin D levels in recent years, many people likely don’t use sunscreen properly and don’t use it consistently enough and so “sunscreen use may not actually diminish vitamin D synthesis in real world use.”

Taking high doses of vitamin D is yet another nutrition fad which has been linked to serious consequences. Mega doses of vitamin D have been linked to kidney problems and tissue damage. That makes it important to stay below the upper limit that your child can likely take each day without causing harm, which ranges from 2,500 IU/day for toddlers to 4,000 IU/day for teenagers. Most only need 400 to 600 IU/day though.

Children with severe vitamin D deficiency are often managed by a pediatric endocrinologist or a pediatric nephrologist.

Like this:

There is no need to use hydrogen peroxide on cuts and scrapes. Use soap and water instead.

You could just parent by instinct, but it is much better to supplement your instinct with a little helpful advice from some of the parents who have come before you.

While some of these things experts figured out through years and years of research, others are simply tips that folks figured out after making mistakes and understanding that there must be a better way to get things done.

Vaccines are safe, necessary, and they work.

Sleep is good. For everyone. Learn to help your baby sleep through the night by the time they are four to six months old.

Three years is not a magic age at which every kid is potty trained. Some take a little longer. The main potty training mistake you can make is to push your kids when they aren’t ready.

Some kids continue to wet the bed at night, even after they are potty trained.

Don’t give aspirin to kids, even teens. It is a risk factor for getting Reye syndrome.

If you still have them, safely dispose of mercury thermometers and syrup of ipecac.

Experts don’t recommend that you use hydrogen peroxide to clean wounds any more. You can usually substitute soap and water instead.

“Starve a fever; feed a cold” is an Old Wives’ Tale, like not drinking milk when your kids have a fever or diarrhea. It is not a real thing. If your child is sick and hungry, let them eat their regular diet. If they are sick and don’t want to eat, encourage them to at least drink a lot of fluids, and add bland foods, until they are ready to eat more.

A green or yellow runny nose almost certainly means that your child has an infection, but unless it has been lingering for weeks or your child has a persistent high fever, then it is likely a viral infection that won’t respond to antibiotics.

When your doctor prescribes antibiotics for your kids, think about whether the prescription is because your sick child needs it or because the doctor thinks you want it. Consider asking if your child might get better without antibiotics.

Don’t force kids to “clean their plates” or eat foods that they really dislike. Picky eaters who are forced to eat are probably more likely to grow up to be picky adult eaters.

Most kids, unless they are missing out on one or more food groups or have a chronic medical problem, probably don’t need a daily vitamin.

Don’t just ask your kids if they are being bullied. Also ask if they ever bully or see kids getting bullied. Someone is doing the bullying.

All kids are different. Don’t compare them. Or at least don’t compare them too much. But talk to your pediatrician if your child’s growth and development really seems off-track compared to most other children.

Some kids are harder to discipline than others. Try something else or get help if what you are doing isn’t working.

Taking extra unnecessary risks, like hiding a loaded gun in the house, not having a fence around your backyard swimming pool, letting your kids ride a bike without a helmet, or letting them ride an ATV, etc., will increase the chances that your kids get hurt. Think about safety.

Not every kid wants to play or is going to be good at team sports.

Being on a “select” sports team probably doesn’t mean what you think it means. The selection process is just as likely to involve the fact that you can pay to be on the team and take extra lessons or classes, as it is to about your child’s skill level.

For perspective, always remember that no matter how good or talented you think your child is, there is always another kid playing at a much higher level. That’s why so few end up playing in college or at higher levels.

At some point, you child might say “I hate you!” Be ready, and understand that it almost certainly has nothing to do with you.